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Pain in the Elderly

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SOCIAL AND DEMOGRAPHIC FEATURES OF OLDER PEOPLE ASSOCIATED WITH DIFFERENT DIMENSIONS OF PAIN

Mark Bradbeer, Stephen J.Gibson, Hal Kendig* and Robert D.Helme. National Ageing Research Inst, Poplar Rd. Parkville, 3052, Australia

Objective: To characterize the prevalence of high intensity pain and high frequency pain, and to determine if age, gender or other social and demographic factors are independently associated with pain report in an elderly population.

Methods: In a cross-sectional study, 1000 randomly selected older (65+years) non-institutional residents of Melbourne, Australia, completed a questionnaire which included questions about their pain experience during the previous year. Different characteristics of pain were analysed by multiple logistic regression for association with demographic and social factors.

Results: After controlling for multiple factors, being a woman showed a weak association with having 'any' pain in the last year (OR=1.3), but no evidence was found for age-related increase in pain within this age range. A more clinically relevant definition for pain is that it be of moderate to severe intensity at worst. This pain (prevalence=48.9%) showed an association with widowhood, living alone and low education, as well as female gender, but multi-variate analysis suggested that living alone was primarily associated with this pain (OR==1.5). A further extreme, moderate to severe pain now (prevalence=4.1%), was also associated with female gender but in multivariate analysis widowhood (OR=3.1) was the primary association. While chronic pain prevalence was 49.6%, persistent (daily chronic) pain prevalence was 21.6% and may comprise a higher proportion of people needing health care. Persistent pain was associated with low education (OR=1.7) and female gender (OR=1.4) which may reflect risk factors for arthritis self-report in this age group.

Conclusion: Pain, in which intensity, immediacy and persistency are precisely defined, show significant independent associations with living alone, widowhood and low education, respectively. These factors all contribute to increased pain prevalence in older women as well as to an apparent female susceptibility to pain attributed to arthritis.

REPORT OF PAIN BY PEOPLE WITH COGNITIVE IMPAIRMENT

Eric Brodie. Catherine Niven, Ailsa Cook; Dept of Psychology, Glasgow Caledonian Univ, Dept of Nursing and Midwifery, Centre for Social Research on Dementia, Dept of Applied Social Science, Univ of Stirling

Aim of Investigation: To examine the ability of people with dementia to report and assess pain.

Methods: 18 elderly subjects with dementia, 83% female whose cognitive ability was assessed using the Mini Mental State Examination (MMSE). Written informed consent was sought for all subjects or obtained from the next of kin. Pain was assessed using the MPQ descriptors, the MPQ's Present Pain Intensity Scale, the Verbal Analogue Scale, and a face scale. Information about each patients' painful conditions and pain state that day was obtained before a first interview when general questions were put about pain presence, location, description and intensity. These were repeated as a reliability check, and orientation before the pain assessment measures were administered.

Results: MMSE scores were spread throughout the full range of cognitive impairment. However 89% could report pain presence and location, including the most impaired subjects. Reports were consistent with the presence of painful conditions and expert judgement of their pain. 73% were able to describe current pain, compare it to previous notable pains, talk about the impact of pain on their lives and its causes. The Present Pain Intensity Scale of the MPQ was found to be the most suitable assessment tool overall but its use, or the use of other pain scales such as the face scales, could not be predicted by MMSE scores.

Conclusion: Cognitive impairment does not prevent people with dementia accurately reporting their pain. Standard pain assessment scales can be used but more research is needed to determine which scales are optimal and why.

ANEURYSM AS A CAUSE OF TRIGEMINAL PAIN

Guilherme C. B. Castro. Carlos Tadeu P. Oliveira, Amauri L. Fischer, Joao B. Andrade, Carmen Silva Sanches, Silvana Maria Ferreira, Fernanda R. Barbosa, Dept of Neurology and Neurosur-gery, Univ ofSao Francisco ofBraganca Pta-SP, Brasil

Aim of Investigation: The present study is to refer the importance of a good investigation in Trigeminal Pain cases even with normal neurological examination.

Methods: We studied the case of a female patient, 78 years old, presenting a 6 year trigeminal pain in V-2 in the rigth side. She was treated with a daily dosage ofcarbamazepine 800mg and fenitoine 300mg, with no success. She looked for our neurological clinic. The neurological examination was entirely normal.

Results: We always investigated trigeminal pain, at least with a brain computed tomography, even with a normal neurological examination, and in this case the ct scan demonstrated a skull base mass, as skull base meningeoma. Digital cerebral angiography showed a rigth carotid oftalmic aneurysm. The surgery to clip the aneurysm was made and, she had a good evoluation with no pain, for the period of 10 days. Then the pain returned with no response to drugs treatement. She was submitted to a percutaneous ballon microcompression, with fogarty 4 F. The patient is keeping a follow up in our clinic presenting no pain during the last 2 years. Results: All trigeminal pain, even with normal neurological examination, requirestobe thoroughly investigated.

AGE DIFFERENCES IN PAIN BELIEFS

Andrew J. Cook. Douglas E. DeGood, Dania C. Chastain, Dept of Anesthesiology, Division of Pain Management, Univ of Virginia Health System, P.O. Box 10010, Charlottesville, VA 22906-0010, USA

Aim of Investigation: To evaluate the relationship between age and pain attitudes or beliefs that are potential barriers to multidisciplin-ary treatment for chronic pain patients.

Methods: Data were obtained from 499 patients evaluated at a multidisciplinary pain clinic over a 17-month period. The patients were 66% female with mean age of 45.3 (SD=14.6, range 13 to 90). For analyses age groupings were: young (13 to 39), middle-age (40 to 59), and elderly (60 to 90). Pain beliefs were assessed by the Cognitive Risk Profile (CRP), a 68-item instrument with nine subscales that reflect cognitive patterns often associated with response to pain treatment. Factor structure and concurrent validity of the CRP have been previously demonstrated.

Results: Preliminary analysis using factorial MANOVA on the nine CRP subscale scores revealed significant main effects (Pillai'scriterion) for gender (F(9,485)=2.1, p<05) and age group (F(18,972)=5.6, p<.001), with no interaction effect. Univariate F-tests showed significant age group effects (p<.006) for CRP sub-scales 1 (Philosophic Beliefs about Pain), 2B (Denial Pain Affects Mood), 3 (Perception of Blame), 4 (Absence of Social/Emotional Support), 6 (Desire for Medical Breakthrough), and 8 (Conviction of Hopelessness). Elderly patients had lowest average risk scores on scales 1, 3, 4, 8 and highest risk scores on scales 2B and 6.

Conclusions: Results show significant age differences for the majority of clinically-relevant pain beliefs assessed. This finding provides empirical support for differences in beliefs commonly described in the clinical literature on chronic pain in the elderly. Differences can be interpreted in terms of life-stage, contextual, and experiential issues.

THE VALIDATION OF THE LONG-FORM MCGILL PAIN QUESTIONNAIRE WITH OLDER PERSONS.

Trevor Corran. Robert Heime, Stephen Gibson. National Ageing Research Inst, North West Hospital, Popular Road, Parkville, Australia 3052.

Aim of Investigation: To validate the Long-Form of the McGill Pain Questionnaire (MPQ) for older persons with chronic pain.

Methods: Two factor analyses were carried out on the responses of 196 consecutive referrals of patients (mean age 74.82, s.d. 7.13, range 60-95) to the MPQ. A Principle Component Analysis with Varimax Rotation was used for the first analysis, using recommended a priori criteria to select the number of factors to be extracted. Four factors were forced for the second solution.

Results: Chronbach's Alpha for the 20 items of the MPQ was 0.8681. This value remained relatively stable when Alpha was recalculated removing each item in turn. No gender differences were found for responses to the items. Five Factors were extracted in the first solution accounting for a total of 54.8% of the variance. These were considered to represent an Affective and four Sensory Factors. The four factors in the second solution accounted for 49.3% of the variance, one Affective and three Sensory Factors were identified. Neither analysis produced an Evaluative Factor. In both analyses the evaluative items tended to load on the Affective Factor.

Conclusions: The predominance of Sensory Factors was consistent with recent studies of younger persons. The confounding of evaluative and affective items may be a function of the age of the subjects in this study and the manner in which they interpret and give meaning to pain. It was gratifying that the MPQ was supported as a valid multidimensional measure of the pain experience with older persons.

PAIN IN ELDERLY

M. Filbet, Chefde Service, Hopital Geriatrique, du Val d'Azergues

Cancer frequency increases with aging and pain assessment may become difficult as dementia or cognition impairment occur. Therefore elderly patients may not complain despite severe pain affecting their mood and functional status.

Although the most effective pain assessment media is a visual analogic scale, but the high prevalence of visual and or hearing impairment in the elderly patient may impede the use of this device.

Therefore a behavioural pain assessment DOLOPLUS SCALE based on posturing as in infants DGR SCALE may be used.

This DOLOPLUS scale relies on ten different items, somatic, psychomotor and psychosocial reactions assessed by B WARY et al. Our purpose is to describe this new scale and it in progress assessment.

PAIN AND OPIOID SELF-ADMINISTRATION FOLLOWING PROSTATECTOMY IN MIDDLE-AGED AND ELDERLY MEN

Lucia Gagliese. Adarose Wowk*, Alan Sandier, Joel Katz, Depts of Psychology and Anaesthesia, The Toronto Hospital, Toronto, Ontario, M5G 2C4, Canada

Aim of Investigation: To investigate age differences in postoperative pain and use of patient controlled analgesia (PCA) following prostatectomy.

Methods: Patients received instruction in the use of PCA prior to surgery. In the recovery room, after surgery, patients received a loading dose ofdemerol or morphine and were immediately placed on a PCA pump. On the first three postoperative days (POD), patients completed the McGill Pain Questionnaire (MPQ), the Present Pain Index (PPI) and a Visual Analog Scale (VAS) of pain intensity. Daily opioid intake was recorded.

Results: Patients were divided into a middle-aged (n=95; mean age 56.4 ± 5.8) and an elderly (n=l 05; mean age = 66.8 ± 2.7) group. Age and time effects were assessed with ANOVA using POD as the repeated factor and age group (AGE) as the between subjects factor. Elderly patients self-administered less opioid than younger patients on POD1 and 2 but not POD3 (AGE X POD; p < 0.001). Pain scores decreased with time in both groups (p < 0.0001). The elderly group reported lower pain levels than the middle-aged patients on the MPQ (p < 0.009) and PPI (p < 0.03) but not the VAS (p<0.33).

Conclusions: Elderly men self-administered less opioid and reported less pain than middle-aged men. The age differences found in pain levels may be dependent on the scale used. Specifically, those comprised of verbal descriptions of pain (MPQ, PPI) yielded different results than that requiring abstract reasoning (VAS). Future studies should explore the sensitivity of different pain scales across the adult life-span.

Acknowledgments: Supported by MRC Grant MT-12052 and NIH Grant NIH-NS35480.

THE ROLE OF COGNITIVE FACTORS IN PAIN AND SUFFERING EXPERIENCED BY OLDER CHRONIC PAIN PATIENTS

Stephen J.Gibson. Robert D. Heime, National Ageing Research Inst, North West Pain Management Centre, PO Box 31, Parkville, VIC. Australia 3052.

Aim of Investigation: There has been some debate regarding the importance of cognitive factors in mediating the relationship between pain and suffering in older adults. The present study sought to examine the relationship between cognitive beliefs, coping strategy use and levels of self rated pain and depression in older patients with chronic pain.

Methods: The sample comprised 196 consecutive patients of the North West Pain Centre, Australia, aged 72.1 years (range 30-95) with 64 males and 126 females. All patients completed a comprehensive battery of psychometric questionnaires on admission and discharge, including the McGill pain questionnaire, Geriatric depression scale, Coping strategies questionnaire, Pain locus of control (PLOC) and VAS of pain interference. Results: An examination of age differences in the 3 subscales of the PLOC revealed a significantly higher belief in chance factors controlling pain severity in adults over 80 years of age (PO.05), but no difference in internal, powerful others locus or in self rated interference from pain. Following treatment, there was a significant increase in feelings of internal control over pain and a decrease in pain interference, regardless of age. Numerous significant correlations were found between PLOC orientation, the use of coping strategies and self rated pain and depression. Step- wise multiple regression analysis indicated that the most important predictors of depressive symptoms were pain interference (accounting for 16.5% of variance) and an internal PLOC (accounting for 4.7% of variance), rather than the level of pain, per se.

Conclusions: Older persons endorse a more external (chance) locus of control when dealing with persistent pain, but this orientation is amenable to change following treatment. In common with younger adults, cognitive beliefs appear to play an important role in accounting for variations in the levels of self-rated pain and depression in older adults with chronic pain.

THE EMOTIONAL AND BEHAVIOURAL IMPACT OF PAIN IN COGNITIVELY IMPAIRED ELDERLY.

Benny Katz. Marcus Gray, Robert D. Heime, Stephen J. Gibson, National Ageing Research Inst, PO Box 31, Parkville, VIC, Australia 3052.

Objective: Diminished cognitive function is likely to interfere with the ability to place pain symptoms within a meaningful context and thereby influence the emotional and behavioural impact of pain, but such studies have yet to be undertaken. The present study sought to examine self reported levels of pain, affective distress and behavioural agitation in older adults of varying cognitive status.

Methods: 100 patients were randomly selected from an acute geri-atric hospital setting (mean age = 78.8) and completed a psychometric evaluation of cognitive status (Mini-mental state exam), pain (Word descriptor scales), depression (Geriatric depression scale), anxiety (Spielberger Anxiety scale) and informant rated behavioural agitation (Cohen-Mansfield agitation inventory).

Results: Patients were divided into cognitively normal (n=44), mild impairment (n=32) and moderate impairment (n=24) on the basis of the mini-mental state exam. Higher levels of affective distress were found among patients suffering from pain and among those with cognitive impairment (p<0.05). A significant interaction suggested a greater magnitude of increase in anxiety and depressive symptoms in patients with pain, when that person also suffered from cognitive impairment. A significant interaction between the presence of pain and reduced cognition was also noted for levels of behavioural agitation. This was mainly due to increased verbal agitation in cognitively impaired adults with pain, whereas cognitively intact adults exhibited reduced verbal agitation when in pain.

Conclusions: It appears that reduced cognition may exacerbate the emotional impact of pain among elderly hospital patients, resulting in higher levels of depressive symptoms, anxiety and verbal agitation. These findings emphasise the importance of providing effective pain management for cognitively impaired persons and underscores the role of cognitive factors in shaping the experience of pain and suffering.

THE EFFECT OF STIMULATION SITE ON DETECTION AND PAIN THRESHOLDS IN YOUNG AND OLDER ADULTS.

Andyda Meliala. Stephen J. Gibson, Robert D. Heime, National Ageing Research Inst, PO Box 31, Parkville, Vie 3052, AU

Aim of Investigation: To investigate the effect of the length of the afferent fibres on detection and pain thresholds.

Methods: 15 young (30.5 ± 9.0 yrs) and 15 older (78.4 ± 7.2 yrs) volunteers were tested at three sites; the lower back, the volar surface of forearm and the dorsum of foot. Vibration, warmth and cold stimuli were used to test detection threshold whereas CO; laser, frequency specific sine wave electrical stimulation (Current Perception Threshold) and mechanical stimuli were used to test detection and pain thresholds. Electrical stimulation activates the afferent fibre directly, whilst vibration, CO; laser and Semmmes-Weinstein mono filaments, warmth and cold stimuli are known to work via receptor activation.

Results: Overall there was no age by site interaction on detection and pain thresholds. Older subjects were significantly (p < 0.05) less sensitive than young subjects to vibration, cold, warm, mechanical and CO; laser stimuli. No significant age difference was found on electrical detection and pain thresholds at 3 frequencies: 5 Hz (C fibres), 250 Hz (AS fibres) and 2000 Hz (Ap fibres).

Conclusions: A subclinical distal axonopathy has been used to explain an age-related decline in somatosensory sensitivity and early studies have shown a more pronounced deficit in the lower extremities. The result of this study does not support the hypothesis of distal axonopathy with advancing age; age-related differences in sensory perception may be better explained by altered receptor properties.

PREVALENCE AND IMPACT OF PAIN IN OLDER ADULTS IN LONG TERM CARE FACILITIES.

Paula R. Mobily, Keela A. Herr. Caria G. Rapp*, Timothy An-sley*, Univ of Iowa, Iowa City, IA, 52242, USA.

Aim of Investigation: To determine the prevalence and characteristics of pain in older adults in long term care settings; and to evaluate the relationship of pain to functional status, interference with life activities and mood/depression.

Methods: Data were collected by semi-structured interview of cognitively intact long term care residents 65 years of age and older using the Brief Pain Inventory (BPI), Multidimensional Pain Inventory (MPI), the Barthel Index, and the Geriatric Depression Scale (GDS) as well as review of pertinent medical records.

Results: 230 subjects from 21 long term care facilities in the state of Iowa completed the data collection process. Data analysis is currently in progress using a series of descriptive and inferential statistical procedures, including chi-square tests of independence, Pearson product-moment correlations, and logistic and multiple regression. Final results will be presented on the poster.

Conclusions: Because of the high incidence of chronic diseases, falls and other health problems associated with aging, older adults are at increased risk for experiencing both acute and chronic pain. Despite recognition that pain is a significant problem for this population, limited attention has been focused on pain and its impact on quality of life for older adults in long term care settings. The results of this research will provide data necessary for developing and evaluating intervention strategies.

Acknowledgment: Supported by NIH/NINR R 19 Academic Research Enhancement Award R15 NR03754.

PAIN MANAGEMENT IN THE ELDERLY: A CLINICAL AUDIT

Sharon Monplaisir. Public Hospital, New Amsterdam, Guyana

Aim of Investigation: Pain is one of the major reasons why elderly persons seek medical care. The aim of this study was to assess the efficacy and adequacy of pain management in elderly patients presenting to a primary physician.

Methods: Patients 75 yr. and older who presented with a primary complaint of pain were studied. Assessment charts were started and the patients followed up during clinic attendance over a 3-month period. The patients were assessed for adequacy of pain control, side effects or complications of treatment and patient overall satisfaction with treatment.

Results: Pain was the primary reason for 74% of all elderly patients seeking care. 20 patients (7M, 13F) were studied. 60% rated their pain management as satisfactory while 40% rated it unsatisfactory. Adverse effects of therapy occurred in 2 patients (10%). Two-thirds of the patients had one or more co-existing medical conditions. Physicians were reluctant to prescribe adequate doses because of fear of possible drug interactions and side effects in patients with diminished physiological reserves. Pain was also poorly evaluated and underestimated as it is often considered a part of the aging process and also because elderly patients have difficulty communicating their feelings to physicians.

Conclusion: Management of pain in the elderly is often inadequate. More attention and care should be devoted to managing pain in this vulnerable group of patients.

THE EFFECT OF PAIN ON QUALITY OF LIFE OF STROKE AND HIP FRACTURED ELDERLY AND THEIR PRIMARY CAREGIVERS (A LONGITUDINAL STUDY)

Z.Nir. D. Galinsky*, Z. Zolotogorsky*, S. Shiran*, Genaric rehabilitation Dep. Soroka Medical Center, Ben-Gurion Univ of the Negev, Beer Sheva, Israel, and Geriatric Psychiatric Clinic, Univ Hospital of Geneva, Switerland

Aim of the study: To identify factors which influence the quality of life (QOL) of disabled elderly patients and their primary caregivers in the rehabilitation process.

Method: 150 stroke patients and 150 hip-fractured patients and their primary caregivers were examined during the first week after admission to the rehabilitation ward, and at 3 and 6 months following discharge to their community.

Results: Pain has a significant effect on the QOL of both patient groups and their caregivers at all 3 times. Pain correlates with depression, self-esteem, control, body- and self- image, social roles and function, perceived family relationships, ADL, IADL, and living arrangement. Over time there is a significant reduction in the pain intensity experienced by hip fractured patients. In turn, stroke patients tend to complain of pain in their affected hemiplegic side. As patients report a decrease in pain and an increase in QOL, their spouses tend to report an opposite response.

Conclusions: The study raises an ethical issue concerning geriatric care; who is really paying the price for the success of rehabilitation efforts? Or, does the rehabilitation of one patient necessarily entail the diminution of the QOL of his/her spouse?

CONTINUOUS EPIDURAL ADMINISTRATION WITH MORPHINE IS SAFE AND EFFECTIVE FOR MANAGEMENT OF POSTOPERATIVE PAIN IN GERIATRIC PATIENTS RECEIVED THORACOTOMY.

Shoko Okamoto. Kohei Kimura, Dept of Anesthetics, Tokyo Met Komagome Hosp, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-0021,Japan

Aim of Investigation: Postoperative pain control is an important method during perioperative management in all patients who received major operations. Thoracotomy is one of operations that induce severe postoperative pain. Continuous epidural administration of analgesics has high risk in the elderly because they often have multiple medical problems. We retrospectively evaluated the safety and the efficacy of continues epidural block in elderly patients (over 80-years old) received thoracotomy.

Methods: Fifty-one patients (male 39 and female 12, average age of 82.0), who received operations for pulmonary cancer between 1985 and 1998 on Dept of Surgery in Komagome Metropolitan Hospital, were anesthetized with volatile or intravenous anesthesia and continuous thoracic epidural block. Morphine 8-10 mg were given continuously via epidural catheter during postoperative 48 or 72 hours. We evaluated the pain relief using visual analog scale and complications.

Results: Postoperative complications were recognized arrhythmia in 28 patients (58%), transient confusion in 16 patients (33%), pneumonia in 9 patients (19%) and gastric bleeding in 2 patients (4%). Neither respiratory nor circulatory depression was observed, and pain control was satisfactory.

Conclusions: Continuous epidural infusion with morphine is safe and effective to alleviate postoperative pain in elderly patients received thoracotomy without major complications.

EVALUATING ITEM BIAS IN THE ASSESSMENT OF DEPRESSION IN NURSING HOME RESIDENTS WITH PERSISTENT PAIN.

Thomas Rudy. Debra Wemer, Pain Evaluation and Treatment Inst, Univ of Pittsburgh, Pittsburgh PA, USA

Aim of Investigation: To explore how the presence of persistent pain may lead to differential item functioning (DIF) or bias when evaluating depression in nursing home (NH) residents.

Methods: 115 NH residents (mean age 78.3 yrs., 56% male) were evaluated daily for the presence of pain. After one week, 35% reported no pain, while 45% report pain on 3 or more days. NH residents then were administered the 30-item Geriatric Depression Scale (GDS). Item Response Theory was used to detect DIF (bias) between GDS items and residents' pain status (absent vs. 3+ days/wk).

Results: Of the 30 GDS items, 8 displayed significant DIF (all ns < 0.001). These items were: (1) dropping many activities and interests, (2) often getting bored, (3) feeling unhappy most of the time, (4) often getting restless and fidgety, (5) feeling that they have more problems with their memory than most, (6) feeling worthless the way they are now, (7) having difficulty getting started on new projects, and (8) feeling that their mind isn't as clear as it used to be.

Conclusions: The significant association between measures of pain severity and depression has received substantial empirical support. Considerable debate remains, however, in explaining the causes and mechanisms of the pain-depression relationship. Since both pain and depression have relatively high prevalence rates in older adults, the diagnosis of depression in older patients with pain is complicated since these two disorders share some common symp; toms. Our results suggest that the presence of persistent pain in nursing home residents significantly biases a substantial number of items in a commonly used, well validated geriatric measure of depression. Future research should evaluate alternative scoring methods that adjust for the bias in certain depression items caused by the presence of a persistent pain condition.

Acknowledgments: Supported in part by an NIA Academic Award #K08 AG00643.

A COMPARISON OF BOTH HOT AND COLD PERCEPTION THRESHOLDS AND HOT AND COLD PAIN THRESHOLDS BETWEEN YOUNG SUBJECTS AND YOUNG-ELDERLY, MIDDLE-ELDERLY AND OLD-ELDERLY SUBJECTS.

Rhonda J. Scudds. Roger A. Scudds, Dept of Rehabilitation Sciences, Medical Univ of South Carolina, Charleston, SC 29425, USA

Aim of Investigation: To investigate both hot and cold perception thresholds, and hot and cold pain thresholds between young (Y) subjects and young-elderly (Y-E), middle-elderly (M-E), and old-elderly (0-E) subjects.

Methods: Healthy volunteer subjects (n = 146) in four age groups were recruited for the study: < 60 years of age (Y); 60-74 years of age (Y-E); 75-84 years of age (M-E); 85 years of age and older (0-E). Using an ascending method of limits, the TSA2001 thermal sensory analyzer (Medoc, Inc.) was used to determine average threshold temperatures for each of four variables: cold sensation (CS), cold pain (CP), warm sensation (WS), and warm pain (WP) in the volar aspect of the mid-forearm.

Results: 40 Y (mean age = 28.6, SD = 6.9), 28 Y-E (mean age 69.3, SD = 4.0), 46 M-E (mean age = 80.2, SD = 3.2), and 42 0-E (mean age = 88.8, SD 3.8) subjects participated in the study. Four oneway ANOVA's revealed statistically significant differences between the four age groups for each of the four variables (CS, p < 0.001; CP, p <0.05; WS, p< 0.001 ;WP,p< 0.001). For WS and WP, the Y group had significantly lower thresholds (more sensitive) than each of the Y-E, M-E, and 0-E groups (p < 0.001). For CS, the Y group had significantly higher thresholds (more sensitive) than each of the M-E (p < 0.05) and 0-E groups (p < 0.001). For CP, the M-E group had significantly higher thresholds (more sensitive) than the Y-E group (p < 0.05).

Conclusions: These data support and extend previous reports of declining sensitivity to heat and cold stimuli in the elderly. However, there seem to be few differences between different groups of healthy elderly subjects.

TREATMENT OF THE BACK PAIN DUE TO SPINAL BONE DISORDERS IN ELDERLY FEMALE PATIENTS.

Naosuke Sugai'. Naoya Maruyama*, Shunnichi Takagi**, Tadashi Aoki*, 'Shimadadai Hospital, Shimadadai, Yachiyo Chibaken 276-0004, Japan, Pain Relief Center and Dept ofAnesthesiology, Hoyo Hospital, Ishidoriyacho, Hienukugun, Iwate 028-3111 Japan, and "Dept ofAnesthesiology, St Marianna Univ School of Medicine, Miyamaeku, Kawasaki, 216 Japan

Aim of Investigation: To investigate the method of treatment appropriate for the back pain of elderly female patients with osteopo-rosis and spondylosis of the spinal bone.

Methods: Twelve elderly female patients (73-90 years of age; average 82.7 years) with back pain were treated. The pain is the result ofosteoporosis, spondylosis and old compression fracture of the spinal bone due to lifetime of heavy agricultural work in rural Japan. On admission the patients were unable to walk. The pain included myofascial pain and radicular pain resulting from the spinal bone disorders. The pain was first treated by nerve block therapy including trigger point injection and caudal block, which was effective in reducing the intense pain. NSAID was also administered. When pain intensity subsided, polarized near infrared radiation (Superlizer, Tokyo Iken Co.) was also used along with physical rehabilitation.

Results: Pain subsided in one to two weeks and all the patients became able to walk in 2 to 9 weeks. Conclusion: In the present study, back pain in elderly women was first treated intensively with nerve block therapy. It is important to reduce the pain as quickly as possible to prevent decubitus and permanent disability. The treatment was successful and the method proved to be valuable in the management of elderly patients with pain from spine problems.

ATTITUDINAL BARRIERS TO EFFECTIVE PAIN MANAGEMENT IN THE NURSING HOME

Debra Weiner. Thomas Rudy, Pain Evaluation and Treatment Inst, Univ of Pittsburgh, Pittsburgh PA, USA

Aim of Investigation: To systematically explore nursing home (NH) resident and staff attitudes that serve as barriers to detection and management of persistent pain.

Methods: We designed two structured pain attitudes questionnaires (one for NH residents and one for NH nurses) that incorporated constructs gleaned from a comprehensive literature review. There were 2 to 3 questions per construct. 38 communicative NH residents (mean age 81.2) with persistent pain and 35 NH nurses (mean length of time in nursing 17 years, 7.9 in NH) answered the questionnaires. Attitudinal responses were graded using a 5-point Likert scale. A summary score for each item was calculated as a mean of the responses for each construct. One week test-retest reliability (ICCs) was calculated on a sub-sample of 25 residents and 15 nurses. Attitudinal differences between the two groups were evaluated with 1-tests.

Results: Of 14 constructs explored, 10 had fair to excellent reliability indices (ICCs: Nurses 0.52-0.87; Residents 0.46-0.80). These were: (1) lack of time, (2) belief that pain is a normal part of aging, (3) belief that pain treatment is unnecessary in the face of adequate function, (4) belief that persistent pain has little potential for change, (5) disbelief in the validity of pain complaints without physical deformity, (6) fear of addiction, (7) fear of functional dependence, (8) desensitization, (9) ageism, and (10) the tendency to stifle pain complaints because of fears they will go unheard. Of these 10 reliable constructs, significant attitude differences between residents and nurses were found for 6 constructs - 2, 3, 4, 5, 7, and 10 (all ps < 0.002). While residents tended to deny constructs 2-7, NH nurses were found to have more neutral attitudes for these constructs. On the other hand, residents more strongly endorsed construct 10.

Conclusions: We have developed a reliable pain attitudes survey that suggests if staff attitudes would improve and residents fears quelled regarding their pain complaints falling on deaf ears, perhaps improved pain management in the NH would result. Such attitude modification is essential in order to improve the quality of life of the frail individuals that suffer with this potentially devastating problem.

Acknowledgments: Supported in part by an NIA Academic Award #K08 AG00643.

9th WORLD CONGRESS ON PAIN, 1999, Vienna, Austria, p.557 - 561

   

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